The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy.

BACKGROUND: Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of "non-selective" measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign. METHODS: We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs. RESULTS: The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs. CONCLUSIONS: Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.

Deployment of novel oral polio vaccine type 2 under emergency use listing in Nigeria: the rollout experience.

In 2011, a dedicated consortium of experts commenced work on the development of the novel oral poliovirus vaccine type 2 (nOPV2). After careful and rigorous analysis of data to enable early, targeted use of the vaccine, World Health Organization´s (WHO´s) Strategic Advisory Group of Experts on Immunization (SAGE) reviewed data from accelerated clinical development of nOPV2 and endorsed entering assessment under WHO´s Emergency Use Listing (EUL) procedure. In November 2020, nOPV2 received an interim recommendation for use under EUL to enable rapid field availability and potential wider rollout of the vaccine. In December 2020, Nigeria initiated preparation to meet all criteria for initial use of nOPV2 in the country and the documentation process to verify meeting them. The process entailed addressing the status of meeting 25 readiness criteria in nine categories for nOPV2 use in Nigeria for response efforts to ongoing cVDPV2 outbreaks. During January-February 2021, Nigeria submitted the required documentation for all required indicators for nOPV2 initial use. In February 2021, the country obtained approval from the GPEI nOPV2 Readiness Verification Team to introduce nOPV2 and in March 2021, rolled out the novel vaccine in mass vaccination campaigns for outbreak response in Bayelsa, Delta, Niger, Sokoto and Zamfara states, and one area council in the Federal Capital Territory (FCT). The lessons learned from this rollout experience in Nigeria are being applied as the country streamlines and strengthens the nOPV2 rollout process across the remaining states.

Exposure of Helicoverpa punctigera pupae to extreme temperatures for extended periods negatively impacts on adult population dynamics and reproductive output.

Understanding the impact that heat stress has on critical life stages of an organism is essential when assessing population responses to extreme events. Heat stress may occur as repeated small-scale events or as a single prolonged event, which may cause different outcomes to the organism. Here, we subjected Helicoverpa punctigera (Wallengren) pupae to two temperatures (44.2 °C and 43 °C) and two exposure treatments - a single 3-h prolonged exposure prolonged and three repeated 1-h exposure period with 24 h recovery time between bouts - to assess the biological traits of individuals. The maximum temperatures were used as they were just below the critical thermal maximum (CTmax) 47.3 °C ± 0.3 °C of pupae for which they could survive exposure. Adults in the prolonged and repeated heat-stressed treatments had 1.70 and 3.34 more days to emergence and 1.57 and 3.30 days extended life span compared to those kept under a constant 25 °C temperature (control treatment). Both pre-oviposition and oviposition periods were extended in the heat-stressed groups. Fecundity in the prolonged and repeated heat-stressed females was reduced by 34.7% and 65.5% eggs in the 43 °C treatment group and by 94.3% and 93.6% eggs in the 44.2 °C treatment group compared to the control group. No eggs from females in either the prolonged and repeated heat-stress groups hatched. We establish that heat stress on pupae can influence the population dynamics of H. punctigera by reducing fecundity as well as extending the pre oviposition period, and affecting adult development. Also, as heat exposure on the parent generation resulted in no offspring production, it is critical to assess cross-generational responses to extreme heat stress.

Estimating the differences in critical thermal maximum and metabolic rate of Helicoverpa punctigera (Wallengren) (Lepidoptera: Noctuidae) across life stages.

Temperature is a crucial driver of insect activity and physiological processes throughout their life-history, and heat stress may impact life stages (larvae, pupae and adult) in different ways. Using thermolimit respirometry, we assessed the critical thermal maxima (CTmax-temperature at which an organism loses neuromuscular control), CO2 emission rate (V́CO2) and Q10 (a measure of V́CO2 temperature sensitivity) of three different life stages of Helicoverpa punctigera (Wallengren) by increasing their temperature exposure from 25 °C to 55 °C at a rate of 0.25 °C min-1 . We found that the CTmax of larvae (49.1 °C ± 0.3 °C) was higher than pupae (47.4 °C ± 0.2 °C) and adults (46.9 °C ± 0.2 °C). The mean mass-specific CO2 emission rate (ml V́CO2 h-1) of larvae (0.26 ± 0.03 ml V́CO2 h-1) was also higher than adults (0.24 ± 0.04 ml V́CO2 h-1) and pupae (0.06 ± 0.02 ml V́CO2 h-1). The Q10: 25-35 °C for adults (2.01 ± 0.22) was significantly higher compared to larvae (1.40 ± 0.06) and Q10: 35-45 °C for adults (3.42 ± 0.24) was significantly higher compared to larvae (1.95 ± 0.08) and pupae (1.42 ± 0.98) respectively. We have established the upper thermal tolerance of H. punctigera, which will lead to a better understanding of the thermal physiology of this species both in its native range, and as a pest species in agricultural systems.

Planning for supplemental immunization activities using the readiness assessment dashboard: Experience from 2017/2018 Measles vaccination campaign, Nigeria.

INTRODUCTION: Globally, supplemental immunization activities (SIAs) are known to be a major strategy for attainment of the global measles elimination goal of less than one measles case per million population within a geographic area by the year 2020. Adequate planning is critical to the success of a vaccination campaign. To achieve a quality SIA implementation for effective interruption of measles transmission, the World Health Organization introduced the SIA Readiness Assessment Tool, which includes the readiness dashboard. It is a strategic planning tool used to ensure critical activities are completed before SIAs. Nigeria implemented a phased measles SIA in 2017/2018 and used the readiness assessment tool in the planning for the campaign. In this article, we report the use of the readiness assessment dashboard in the 2017/2018 measles SIA, we also reviewed its contributions to the outcome of the campaign looking at the post campaign coverage survey results for the states. METHODS: We conducted a retrospective review of the readiness assessment dashboard used during the 2017/2018 measles vaccination campaign in Nigeria. The readiness dashboard tool was designed using Microsoft Excel 2016. We reported results in frequencies and proportions using charts and tables. RESULTS: The states with 100% readiness a week prior to the campaign scored a post campaign coverage survey result of 84.6 - 96.5% with just one out of the eight states in this category getting a score below 90%. In the same vein, of the eight states that their readiness score at one week to the campaign was below 85%, six had post campaign coverage survey score of less than 90% with the highest score in this category being 92.3%. Some states with good readiness scores also had poor post campaign coverage survey which has been attributed to other factors other than readiness. CONCLUSION: The readiness assessment dashboard for the measles vaccination campaign provided a platform for tracking states readiness. It is our view that a link between readiness assessment and coverage should be examined in future studies.

Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up.

BACKGROUND: The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. METHODS: We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. RESULTS: All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. CONCLUSION: Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria's efforts in measles control and elimination.

Microplanning verification and 2017/2018 measles vaccination campaign in Nigeria: Lessons learnt.

INTRODUCTION: The measles supplemental immunisation activity is an effective strategy that improves vaccination coverage and reduces measles-related morbidity and mortality. However, the lack of compliance with microplanning processes, contributes to improper estimation of resources needed for a good SIA in Nigeria. We described the microplanning verification process for 2017/2018 measles vaccination campaign and highlighted the contribution of selected variables to the output of the microplan. METHODS: We conducted microplanning verification in 2 phases. In Phase 1, we verified at least 30% of randomly selected microplans to assess compliance with the steps and processes of developing good microplans. In Phase 2 we conducted desk review of the entire states micoplans and verified some selected variables at the ward level to corroborate the findings of the microplans. We collected data using open data kit and verification checklist. We conducted data analysis using SPSS and Microsoft Excel version 2016. RESULTS: All states in Nigeria verified their wards' microplans, 21 states (57%) verified more than 30% ,16 states (43%) verified less than 30%, Kebbi State verified the lowest (5.3%). Over 90% of microplans verified complied with the microplanning processes. We observed that overall, there was no significant difference in the number of target population, vaccination teams and qualified vaccinators after the verification process. CONCLUSION: The microplans for 2017/2018 measles vaccination campaign were developed according to the required procesesses, the target population, vaccination teams and qualified vaccinators were physically and realistically estimated. Adherence to microplanning processes is critical to the success of immunization programs.

Trends in measles incidence and measles vaccination coverage in Nigeria, 2008-2018.

INTRODUCTION: All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9-59 months), and intensified measles case-based surveillance system. METHODS: We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017-18. Additionally, we analyzed measles case-based surveillance reports from 2008-2018 to determine annual, regional and age-specific incidence rates. FINDINGS: Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9-11 months (524.0 per million) and 12-59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million). CONCLUSION: The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals.

Ensuring accountability in implementation of supplementary immunisation activities: A case study of the 2017/2018 measles vaccination campaign in Nigeria.

INTRODUCTION: Globally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. METHODS: We identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013-2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. FINDINGS: We found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. CONCLUSION: We have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.

Potential for improving routine immunisation waste management using measles vaccination campaign 2017 in Kebbi State, Nigeria.

BACKGROUND: Immunisation activities generate sharps and infectious non-sharp waste that have harmful impact on the community and health care workers if disposed of improperly, leading to carbon mono oxide (CO) emissions which contribute to global warming. Health care waste is not effectively managed, especially in some developing countries. However, measles supplemental immunisation activities (SIAs) are used to strengthen routine immunisation system, including waste management. The waste management planning provides an opportunity to build capacity, mobilize resources and strengthen structures to ensure continual disposal of routine immunisation waste. METHODS: We reviewed the Kebbi State and LGA routine immunisation waste management situation and identified existing gaps; developed and implemented the plan for waste management, including strengthening routine immunisation waste management. The process included, reactivation of measles technical coordination committee, mobilizing resources for funding, and sustenance of immunisation waste management. The health care workforce was trained in safe immunisation waste disposal practices. RESULTS: Immunisation waste management committee and the structure was established and strengthened at the state and LGA levels and a total cost of 11,710.70 USD was expended on injection waste management, with an average cost per injection of 0.01 USD. A total of 11,829 safety boxes were incinerated in the state, including those generated from routine immunisation sessions. Twenty-one Local Immunisation Officers, 1097 and 2192 team supervisors and healthcare worker vaccinators respectively were trained on immunisation waste disposal. CONCLUSION: Immunisation waste management strategies protect healthcare workers and reduce the adverse impact on the environment. Improving key areas such as human and financial resources ensures accountability towards sustainable healthcare waste management.

Application of the Geographic Information System (GIS) in immunisation service delivery; its use in the 2017/2018 measles vaccination campaign in Nigeria.

BACKGROUND: As global effort is made towards measles elimination, the use of innovative technology to enhance planning for the campaign has become critical. GIS technology has been applied to track polio vaccination activities in Nigeria with encouraging outcomes. Despite numerous measles vaccination campaigns after the first catch up campaign in 2005, sub-optimal outcomes of previous measles supplemental immunization activities necessitated the use of innovative ideas to achieve better outcomes especially when planning for the 2017/2018 measles vaccination campaign. This led to the application of the use of the GIS technology for the Northern states in 2017/2018 campaign. This study is a report of what was achieved with the use of the GIS in the 2017/2018 measles vaccination campaign in Nigeria. METHODS: GIS generated ward maps were used for the microplanning processes for the 2017/2018 measles vaccination campaign. These ward maps had estimates of the target population by settlements, the number and location of vaccination posts ensuring that a vaccination post is sited within one-kilometer radius of a settlement, and the number of teams needed to support the vaccination campaign as well as the catchment area and daily implementation plans. The ward microplans were verified by checking for accuracy and consistency of the target population, settlements, number of teams, vaccination posts and daily implementation work plans using a standard checklist. The ward maps were deployed into use for the measles vaccination campaign after the state team driven validation and verification by the National team (Government and Partners) RESULTS: The Northern states that applied the GIS technology had a closer operational target population to that on the verified microplan than those of the non-GIS technology states. Greater than 90% of the ward maps had all that is expected in the maps - i.e settlements, target populations, and vaccination posts captured, except Kaduna, Katsina and Adamawa states. Of all enumeration areas sampled during the post-campaign survey in states with GIS ward maps, none had a zero-vaccination coverage of the surveyed children, with the exception of one in Borno state that had security issues. In the post campaign coverage survey, the percentage of responses that gave vaccination post being too far as a reason for non-vaccination of children in the Northern zones that used GIS generated ward maps was less than half the rate seen in the southern zones where the GIS microplanning was not used. CONCLUSION: The use of GIS-generated wards maps improved the quality of ward micro plans and optimized the placement of vaccination posts, resulting in a significant reduction in zero-dose clusters found during the post campaign coverage survey.

Internal displacement; an impediment to the successful implementation of planned measles supplemental activities in Nigeria, a case study of Benue State.

BACKGROUND: Measles is a highly infectious disease with great burden and implication on a displaced population with low immunity status. The disease can cause up to 140,000 deaths annually. Internal displacement during supplemental immunization activities often affects optimal reach and coverage of the campaign as people move and implementation and logistic plans are usually disrupted with attendant missed children. This study documented the process of extension of the measles vaccination campaign (MVC) 2018 for five internally displaced persons (IDPs) camps in Benue state, not previously in the microplan, to increase population herd immunity. METHODS: We obtained population figures and disease surveillance data for five IDPs camps and used it to conduct detailed microplanning to determine the requirement for the conduct of additional days of measles vaccination. Vaccination teams used fixed posts in the camps and temporary posts strategy in designated locations in the host communities. RESULTS: The estimated total population of the IDPs was 170,000 with MVC target population of 9374 which was not earlier planned for. There was reported measles outbreaks in IDP camps in both Guma and Makurdi Local Government areas (LGAs) during period of displacement. Microplans requirement determined 10,421 bundled measles vaccine, 30 health workers, 5 vehicles and 15 motorcycles. A total of 7679 out of 9374 (81.9%) of the eligible children aged 9-59 months were vaccinated during the 3 days of the campaign. CONCLUSION: Non-inclusion of plans on internally displaced population in supplemental immunization activities (SIAs) microplans have a potential risk of vaccine preventable diseases (VPDs) outbreak. Future Measles Vaccination campaigns should take cognizance of internal displacement due to insecurity and other humanitarian emergencies.

Field investigation and response to a vaccine-derived poliovirus pre-tOPV switch in Southwest Nigeria, October 2015.

A vaccine-derived poliovirus (VDPV) was isolated in an acute flaccid paralysis (AFP) case reported from Ile-Ife, in Osun state, Southwest Nigeria. We investigated the epidemiological characteristics of the polio event and described the immediate public health response that followed. We interviewed the primary caregiver of the case and conducted active case searches for additional AFP cases in the communities in Ife East Local Government Area (LGA) of Osun state. Stool samples of contacts and non-contacts were collected and sent for laboratory investigation. A public health response with mass supplementary immunization in the affected areas followed immediately in the ward the case was located in October 2015. Also, we reviewed the administrative record of the oral polio vaccine (OPV) coverage in the LGA in the previous four years. The VDPV case was a female, one-month-old child with adequate vaccination history for her age. However, the environment of the child was relatively filthy with inappropriate facilities. Laboratory reports from contact samples were negative for VDPV or any polio isolates. A missed AFP case was found from active case searches and a high proportion of under-five children was immunized with tOPV. The OPV3 administrative coverage in the LGA peaked in 2014 (103%) and dropped in 2015 (67%). Efforts directed toward improving environmental hygiene in households and improving OPV coverage in subsequent routine and supplementary immunization are suggested.

The use of WhatsApp group messaging in the coordination of measles supplemental immunization activity in Cross Rivers State, Nigeria, 2018.

INTRODUCTION: Cross Rivers State, in southern Nigeria, conducted measles Supplemental Immunization Activities (SIAs) in 2 phases from 2 -15 March, 2018. The SIAs coordination was led by the State technical coordination committee. A total of 90 supervisors from the national and subnational levels, including consultants were deployed to support the SIAs. The instant messaging service - WhatsApp was utilized to help in the communication and coordination among the State and field teams. METHODS: We reviewed the chat logs from the WhatsApp group exchanges made between 28 February 2018 and 31 March 2018. Thematic content analysis was done. RESULTS: A total of 653 WhatsApp messages were posted among the 55 group members during the study period, including text messages and media content. Eleven percent of the posts related to monitoring processes and data sharing, while posts related to vaccine logistics and waste management made up about 6% of the total. Overall coordination and deployment was covered in 6% of the posts. Forty percent of the media content showed vaccination service delivery and SIAs launching events or monitoring meetings in various areas. The coordination team used WhatsApp to send reminders to the field staff about data sharing, vaccine and waste management, as well as feedback on coverage and completeness of data sharing. The WhatsApp group discussions did not include most of the logistical and hesitancy challenges documented in the State SIAs technical report. CONCLUSION: We recommend focusing group discussions on instant messaging platforms so that they can be used for problem solving and sharing best practices, integrating it with other supervisory processes and tools, as well as providing feedback based on processed data from the field.

Using the polio programme to deliver primary health care in Nigeria: implementation research.

Objective: To evaluate a project that integrated essential primary health-care services into the oral polio vaccine programme in hard-to-reach, underserved communities in northern Nigeria. Methods: In 2013, Nigeria's polio emergency operation centre adopted a new approach to rapidly raise polio immunity and reduce newborn, child and maternal morbidity and mortality. We identified, trained and equipped eighty-four mobile health teams to provide free vaccination and primary-care services in 3176 hard-to-reach settlements. We conducted cross-sectional surveys of women of childbearing age in households with children younger than 5 years, in 317 randomly selected settlements, pre- and post-intervention (March 2014 and November 2015, respectively). Findings: From June 2014 to September 2015 mobile health teams delivered 2 979 408 doses of oral polio vaccine and dewormed 1 562 640 children younger than 5 years old; performed 676 678 antenatal consultations and treated 1 682 671 illnesses in women and children, including pneumonia, diarrhoea and malaria. The baseline survey found that 758 (19.6%) of 3872 children younger than 5 years had routine immunization cards and 690/3872 (17.8%) were fully immunized for their age. The endline survey found 1757/3575 children (49.1%) with routine immunization cards and 1750 (49.0%) fully immunized. Children vaccinated with 3 or more doses of oral polio vaccine increased from 2133 (55.1%) to 2666 (74.6%). Households' use of mobile health services in the previous 6 months increased from 509/1472 (34.6%) to 2060/2426(84.9%). Conclusion: Integrating routine primary-care services into polio eradication activities in Nigeria resulted in increased coverage for supplemental oral polio vaccine doses and essential maternal, newborn and child health interventions.

Targeting the last polio sanctuaries with Directly Observed Oral Polio Vaccination (DOPV) in northern Nigeria, (2014-2016).

BACKGROUND: The declaration of poliomyelitis eradication as a programmatic emergency for global public health by the 65th World Health Assembly in 2012 necessitated innovations and strategies to achieve results. Review of the confirmed polio cases in 2013 showed that most of the cases were from non-compliant households, where parents connived with vaccinators to finger mark the children without actually vaccinating the children with oral polio vaccine or children were absent from home at the time of the visit of vaccinators. METHODS: We used pre-post design to quantify the outcomes of directly observed vaccination in 90 local government areas from 12 northern Nigeria states at very high risk of polio transmission. The strategy is an intervention, vaccinating children under the direct supervision of an independent supervisor to ensure compliance. Attractive incentives (pluses) were used to make parents willingly submit their children for vaccination or directly attract children to the vaccination teams or post as part of this strategy. RESULTS: There was a steady increase in population immunity in all the 90 DOPV implementing LGAs since the introduction of DOPV in 2013. The number of states in which > 90% of children received > 4 OPV doses increased from 7 in 2013 to 11 states by July 2016. Yobe state reported the highest proportional increase from 75 to 99% by July 2016 (22% increase), while Kano state reported 17% increase, from 82 to 99% by July 2016. CONCLUSION: Directly observed polio vaccination strategy improved uptake of polio vaccines and population immunity in high-risk areas for polio transmission.

Polio eradication in Nigeria: evaluation of the quality of acute flaccid paralysis surveillance documentation in Bauchi state, 2016.

BACKGROUND: Nigeria is the only country in Africa that is yet to be certified as polio free. Surveillance for acute flaccid paralysis (AFP) is the foundation of the polio eradication initiative since it provides information to alert both health managers and clinician that timely actions should be initiated to interrupt transmission of the polio virus. The strategy also provides evidence for the absence of wild poliovirus. This evaluation was performed to assess key quality indicators defined by the polio eradication program and thus to identify gaps to allow planning for corrective measures to achieve a polio-free situation in Bauchi state and in Nigeria at large. We conducted a cross-sectional descriptive study which involved a desk review of documents to authenticate the correctness and completeness of data, and a review of documented evidence for the quality of AFP surveillance. We interviewed Local Government Authority (LGA) surveillance officers and clinicians from focal and non-focal sites, along with caregivers of children with AFP and community leaders. The data were entered and analyzed in a Microsoft Excel spreadsheet. METHODS: We conducted a cross-sectional study of the AFP surveillance and documentation in eighteen of the twenty Local Government Areas (LGAs) of Bauchi State. We assessed the knowledge of the clinician at focal and non-focal sites on case definition of AFP, the number and method of stool specimen collection to investigate a case and types of training received for AFP surveillance. We verified AFP case investigations for the last three years: The caregivers (mothers) were interviewed to authenticate the reported information of AFP cases, the method used for stool specimen collection and feedbacks. Community leaders' knowledge on AFP surveillance was also assessed. Data was entered and analyzed in excel spread sheet. RESULTS: Of the 18 LGA Disease Surveillance and Notification Officers (DSNOs), only 2 (11%) and 5 (28%) had reports of polio outbreak investigations and supervisory visits at the lower levels, respectively. Furthermore, only 6 (33%) and 7 (39%) of the DSNOs had minutes of meetings and surveillance work plans, respectively. Of the 31 AFP cases investigated, only 39, 26, 23, and 23% had correct and complete information for the birth day, birth month, date of onset of paralysis, and date of investigation, respectively. Seventy-one percent of the clinicians at the AFP focal sites knew the correct definition for AFP compared with only 30% at the non-focal sites. Of the 38 caregivers (mothers), 16 (42%) did not remember the day or month the AFP investigation was conducted. However, 95% gave a correct number of stool samples collected and 40% mentioned that the samples were collected 24 h apart. Feedback was not given to 26 (68%) of the caregivers. The majority (79%) of the community leaders knew how to recognize a case of AFP and knew that the stool was the specimen required for the investigation, but 21% did not know to whom they should report a case of AFP in their community. CONCLUSION: This study revealed a gap in the quality indicators for polio eradication in the state, especially regarding knowledge and documentation for AFP surveillance at the operational level. Regular training of the DSNOs and focal persons, regular sensitization of clinicians, community education, supplies of reporting tools, and ensuring their judicious use will improve AFP surveillance in the state.

Mobilizing political support proved critical to a successful switch from tOPV to bOPV in Kano, Nigeria 2016.

BACKGROUND: Kano is one of the high-risk states for polio transmission in Northern Nigeria. The state reported more cases of wild polioviruses (WPVs) than any other state in the country. The Nigeria Demographic and Health Survey of 2013 indicated that OPV3 coverage in the routine immunization (RI) programmewas 57.9%. Additionally, serial polio seroprevalence studies conducted from 2011 to 2015 in the eightmetropolitan LGAs indicated low immunity levels against all three polio serotypes in children below one year. Areas with sub-optimal RI coverage such as Kanothat fail to remove all tOPV during the tOPV-bOPV switchwill be at increased risk of VDPV2 circulation. METHODS: We assessed the impact of political leadership engagement in mobilizing other stakeholders on the outcomes of the bOPV-tOPV switch in Kano State from February to May 2016 using nationally-selected planning and outcome indicators. RESULTS: A total of 670 health facilities that provide RI services were assessed during the pre-switch activities. Health workers were aware of the switch exercise in 520 (95.1%) of the public health facilities assessed. It was found that health workers knew what to do should tOPV be found in any of the 521 (95.2%)public health facilities assessed. However, there was a wide disparity between the public and private health practitioners' knowledge on basic concepts of the switch. There was 100% withdrawal of tOPV from the state and the seven zonal cold stores. Unmarked tOPVwas found in the cold chain system in 2 (4.5%) LGAs. Only one health facility (0.8%) had tOPV in the cold chain. No tOPVwas identified outside the cold chain without the "Do not use" sticker in any of the health facilities. CONCLUSION: The engagement of the political leadership to mobilize other key stakeholders facilitated successful implementation of the tOPV-bOPVswitch exercise and provided opportunity to strengthen partnerships with the private health sector in Kano State.

Impact of engaging security personnel on access and polio immunization outcomes in security-inaccessible areas in Borno state, Nigeria.

BACKGROUND: Nigeria was polio free for almost 2 years but, with the recent liberation of areas under the captivity of insurgents, there has been a resurgence of polio cases. For several years, these inaccessible areas did not have access to vaccination due to activities of Bokoharam, resulting in a concentration of a cohort of unvaccinated children that served as a polio sanctuary. This article describes the processes of engagement of security personnel to access security-compromised areas and the impact on immunization outcomes. METHODS: We assessed routine program data from January 2016 to July 2016 in security-inaccessible areas and we evaluated the effectiveness of engaging security personnel to improve access to settlements in security-compromised Local Government Areas (LGAs) of Borno state. We thereafter evaluated the effects of this engagement on postcampaign evaluation indicators. RESULTS: From 15 LGAs accessible to vaccination teams in January 2016, there was a 47% increase in July 2016. The number of wards increased from 131 in January to 162 in July 2016, while the settlement numbers increased from 6050 in January to 6548 in July 2016. The average percentage of missed children decreased from 8% in January to 3% in July 2016, while the number of LGAs with ≥ 80% coverage increased from 85% in January to 100% in July 2016. CONCLUSION: The engagement of security personnel in immunization activities led to an improved access and improvement in postcampaign evaluation indicators in security-compromised areas of a Nigerian state. This approach promises to be an impactful innovation in reaching settlements in security-compromised areas.